tbuckley/cabot-search huggingface dataset:
Assessment of Sex Disparities in Nonacceptance of Statin Therapy and Low-Density Lipoprotein Cholesterol Levels Among Patients at High Cardiovascular Risk
Authors: C. Justin Brown, Lee-Shing Chang, Naoshi Hosomura, Shervin Malmasi, Fritha Morrison, Maria Shubina, Zhou Lan, Alexander Turchin
Journal: JAMA Network Open (2023)

Importance Many patients at high cardiovascular risk—women more commonly than men—are not receiving statins. Anecdotally, it is common for patients to not accept statin therapy recommendations by their clinicians. However, population-based data on nonacceptance of statin therapy by patients are lacking. Objectives To evaluate sex disparities in nonacceptance of statin therapy and assess their association with low-density lipoprotein (LDL) cholesterol control. Design, Setting, and Participants A retrospective cohort study was conducted from January 1, 2019, to December 31, 2022, of statin-naive patients with atherosclerotic cardiovascular disease, diabetes, or LDL cholesterol levels of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or more who were treated at Mass General Brigham between January 1, 2000, and December 31, 2018. Exposure Recommendation of statin therapy by the patient’s clinician, ascertained from the combination of electronic health record prescription data and natural language processing of electronic clinician notes. Main Outcomes and Measures Time to achieve an LDL cholesterol level of less than 100 mg/dL. Results Of 24 212 study patients (mean [SD] age, 58.8 [13.0] years; 12 294 women [50.8%]), 5308 (21.9%) did not accept the initial recommendation of statin therapy. Nonacceptance of statin therapy was more common among women than men (24.1% [2957 of 12 294] vs 19.7% [2351 of 11 918]; P &amp;amp;lt; .001) and was similarly higher in every subgroup in the analysis stratified by comorbidities. In multivariable analysis, female sex was associated with lower odds of statin therapy acceptance (0.82 [95% CI, 0.78-0.88]). Patients who did vs did not accept a statin therapy recommendation achieved an LDL cholesterol level of less than 100 mg/dL over a median of 1.5 years (IQR, 0.4-5.5 years) vs 4.4 years (IQR, 1.3-11.1 years) ( P &amp;amp;lt; .001). In a multivariable analysis adjusted for demographic characteristics and comorbidities, nonacceptance of statin therapy was associated with a longer time to achieve an LDL cholesterol level of less than 100 mg/dL (hazard ratio, 0.57 [95% CI, 0.55-0.60]). Conclusions and Relevance This cohort study suggests that nonacceptance of a statin therapy recommendation was common among patients at high cardiovascular risk and was particularly common among women. It was associated with significantly higher LDL cholesterol levels, potentially increasing the risk for cardiovascular events. Further research is needed to understand the reasons for nonacceptance of statin therapy by patients and to develop methods to ensure that all patients receive optimal therapy in accordance with their preferences and priorities.
Importance of Optimizing Cardiorespiratory Fitness in Early Adulthood and Through Midlife
Authors: Hermes Florez, JacKetta R. Cobbs, Mathew J. Gregoski
Journal: JAMA Network Open (2023)

Kelley Pettee Gabriel, PhD; Byron C. Jaeger, PhD; Cora E. Lewis, MD, MSPH; Stephen Sidney, MD; Erin E. Dooley, PhD; Mercedes R. Carnethon, PhD; David R. Jacobs Jr, PhD; Bjoern Hornikel, PhD; Jared P. Reis, PhD; Pamela J. Schreiner, PhD; James M. Shikany, DrPH; Kara M. Whitaker, PhD; Alexander Arynchyn, MD, PhD; Barbara Sternfeld, PhD
Epsilon toxin–producing Clostridium perfringens colonize the multiple sclerosis gut microbiome overcoming CNS immune privilege
Authors: Yinghua Ma, David Sannino, Jennifer R. Linden, Sylvia Haigh, Baohua Zhao, John B. Grigg, Paul Zumbo, Friederike Dündar, Daniel Butler, Caterina P. Profaci, Kiel Telesford, Paige N. Winokur, Kareem R. Rumah, Susan A. Gauthier, Vincent A. Fischetti, Bruce A. McClane, Francisco A. Uzal, Lily Zexter, Michael Mazzucco, Richard Rudick, David Danko, Evan Balmuth, Nancy Nealon, Jai Perumal, Ulrike Kaunzner, Ilana L. Brito, Zhengming Chen, Jenny Z. Xiang, Doron Betel, Richard Daneman, Gregory F. Sonnenberg, Christopher E. Mason, Timothy Vartanian
Journal: Journal of Clinical Investigation (2023)

Multiple Sclerosis (MS) is a complex disease of the CNS thought to require an environmental trigger. Gut dysbiosis is common in MS, but specifically causative species are unknown. To address this knowledge gap, we used sensitive and quantitative PCR detection to show that people with MS were more likely to harbor and show a greater abundance of epsilon toxin (ETX)-producing strains of C. perfringens within their gut microbiomes compared to healthy controls (HC). MS patient-derived isolates produced functional ETX and had a genetic architecture typical of highly conjugative plasmids. In the active immunization model of experimental autoimmune encephalomyelitis (EAE), where pertussis toxin (PTX) is used to overcome CNS immune privilege, ETX can substitute for PTX. In contrast to PTX-induced EAE, where inflammatory demyelination is largely restricted to the spinal cord, ETX-induced EAE caused demyelination in the corpus callosum, thalamus, cerebellum, brainstem, and spinal cord, more akin to the neuroanatomical lesion distribution in MS. CNS endothelial cell transcriptional profiles revealed ETX-induced genes that are known to play a role in overcoming CNS immune privilege. Together, these findings suggest that ETX-producing C. perfringens strains are biologically plausible pathogens in MS that trigger inflammatory demyelination in the context of circulating myelin autoreactive lymphocytes.
Updated Disclosures
Authors: Ralph Snyderman
Journal: JAMA (2023)

2 In listing potential conflicts of interest, I disclosed relationships with companies I judged were relevant or reasonably related to the views I expressed, as suggested by guidance from the International Committee of Medical Journal Editors.The first Letter 1 responded to a manuscript titled "Seven Questions for Personalized Medicine." 3 The article expressed disappointment with the impact of personalized medicine on the practice of health care.We believed that the authors conflated personalized medicine with genomic medicine and overlooked the contributions of predictive molecular diagnostics.Our Letter made 2 points: (1) personalized medicine is more than genomic medicine, and (2) molecular diagnostics, a component of personalized medicine, was already enhancing medical care.Given these 2 points, I listed as potential conflicts the boards I served on that I thought were relevant to the letter: CareDx, Nodality, Press Ganey, and Crescendo Biosciences.The second Letter 2 discussed the impact of the Affordable Care Act on improving health care through the value of enhanced access to care. 4 We agreed but raised the point that to improve health, access to care should be accompanied by more effective delivery of care.Personalized, preventive, and participatory care was used as an example.I could identify no boards that I was on that I thought were relevant to the very general concept raised.Given current emphasis on broader disclosure of conflict of interest, if writing these Letters today I would include the aforementioned boards in both Letters and add relationships during the 3 years preceding their writing.These include the boards of Targacept
Effect of food additives on key bacterial taxa and the mucosa-associated microbiota in Crohn’s disease. The ENIGMA study
Authors: J.J. Jimenez Loayza, S. Kang, L. Schooth, J. J. Teh, A. de Klerk, E. K. Noon, J. Zhang, J. Hu, A. L. Hamilton, A. Wilson-O’Brien, G. L. Trakman, W. Lin, J. Ching, L. Or, J.J.Y. Sung, J. Yu, S.C. Ng, M.A. Kamm, M. Morrison
Journal: Gut Microbes (2023)

Food additives have been linked to the pro-inflammatory microbial dysbiosis associated with Crohn's disease (CD) but the underlying ecological dynamics are unknown. Here, we examine how selection of food additives affects the growth of multiple strains of a key beneficial bacterium (Faecalibacterium prausnitzii), axenic clinical isolates of proinflammatory bacteria from CD patients (Proteus, Morganella, and Klebsiella spp.), and the consortia of mucosa-associated microbiota recovered from multiple Crohn's disease patients. Bacterial growth of the axenic isolates was evaluated using a habitat-simulating medium supplemented with either sodium sulfite, aluminum silicate, carrageenan, carboxymethylcellulose, polysorbate 80, saccharin, sucralose, or aspartame, intended to approximate concentrations found in food. The microbial consortia recovered from post-operative CD patient mucosal biopsy samples were challenged with either carboxymethylcellulose and/or polysorbate 80, and the bacterial communities compared to unchallenged consortia by 16S rRNA gene amplicon profiling. Growth of all F. prausnitzii strains was arrested when either sodium sulfite or polysorbate 80 was added to cultures at baseline or mid-exponential phase of growth, and the inhibitory effects on the Gram-negative bacteria by sodium sulfite were conditional on oxygen availability. The effects from polysorbate 80, saccharin, carrageenan, and/or carboxymethylcellulose on these bacteria were strain-specific. In addition to their direct effects on bacterial growth, polysorbate 80 and/or carboxymethylcellulose can drive profound changes in the CD mucosa-associated microbiota via niche expansion of Proteus and/or Veillonellaceae – both implicated in early Crohn's disease recurrence. These studies on the interaction of food additives with the enteric microbiota provide a basis for dietary management in Crohn's disease.
<scp>BTEX</scp> exposure and its body burden pose differential risks for asthma and its phenotypic clusters
Authors: Yuan‐Ting Hsu, Chao‐Chien Wu, Chin‐Chou Wang, Wen‐Yu Chung, Chau‐Chyun Sheu, Yi‐Hsin Yang, Ming‐Yen Cheng, Ruay‐Sheng Lai, Sum‐Yee Leung, Chi‐Cheng Lin, Yu‐Feng Wei, Ching‐Hsiung Lin, Sheng‐Hao Lin, Jeng‐Yuan Hsu, Wei‐Chang Huang, Chia‐Cheng Tseng, Yung‐Fa Lai, Meng‐Hsuan Cheng, Huang‐Chi Chen, Chih‐Jen Yang, Chian‐Heng Su, Chien‐Jen Wang, Shih‐Chang Hsu, Chih‐Hsing Hung, Chon‐Lin Lee, Ming‐Shyan Huang, Shau‐Ku Huang
Journal: Allergy (2023)
Borderline Personality Disorder
Authors: Falk Leichsenring, Nikolas Heim, Frank Leweke, Carsten Spitzer, Christiane Steinert, Otto F. Kernberg
Journal: JAMA (2023)

Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services.Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one's self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between -0.60 and -0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam.Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.
An Education
Authors: Brian Yinge Zhao
Journal: JAMA (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Spatial Positioning of Immune Hotspots Reflects the Interplay between B and T Cells in Lung Squamous Cell Carcinoma
Authors: Hanyun Zhang, Khalid AbdulJabbar, David A. Moore, Ayse Akarca, Katey S.S. Enfield, Mariam Jamal-Hanjani, Shan E. Ahmed Raza, Selvaraju Veeriah, Roberto Salgado, Nicholas McGranahan, John Le Quesne, Charles Swanton, Teresa Marafioti, Yinyin Yuan
Journal: Cancer Research (2023)

Abstract Beyond tertiary lymphoid structures, a significant number of immune-rich areas without germinal center-like structures are observed in non–small cell lung cancer. Here, we integrated transcriptomic data and digital pathology images to study the prognostic implications, spatial locations, and constitution of immune rich areas (immune hotspots) in a cohort of 935 patients with lung cancer from The Cancer Genome Atlas. A high intratumoral immune hotspot score, which measures the proportion of immune hotspots interfacing with tumor islands, was correlated with poor overall survival in lung squamous cell carcinoma but not in lung adenocarcinoma. Lung squamous cell carcinomas with high intratumoral immune hotspot scores were characterized by consistent upregulation of B-cell signatures. Spatial statistical analyses conducted on serial multiplex IHC slides further revealed that only 4.87% of peritumoral immune hotspots and 0.26% of intratumoral immune hotspots were tertiary lymphoid structures. Significantly lower densities of CD20+CXCR5+ and CD79b+ B cells and less diverse immune cell interactions were found in intratumoral immune hotspots compared with peritumoral immune hotspots. Furthermore, there was a negative correlation between the percentages of CD8+ T cells and T regulatory cells in intratumoral but not in peritumoral immune hotspots, with tertiary lymphoid structures excluded. These findings suggest that the intratumoral immune hotspots reflect an immunosuppressive niche compared with peritumoral immune hotspots, independent of the distribution of tertiary lymphoid structures. A balance toward increased intratumoral immune hotspots is indicative of a compromised antitumor immune response and poor outcome in lung squamous cell carcinoma. Significance: Intratumoral immune hotspots beyond tertiary lymphoid structures reflect an immunosuppressive microenvironment, different from peritumoral immune hotspots, warranting further study in the context of immunotherapies.
Critical Care and the Postintensive Care Syndrome
Authors: Micah T. Long, Robert D. Sanders, Jean-Charles Preiser
Journal: JAMA Network Open (2023)

Shawniqua Williams Roberson, MEng, MD; Samuel Nwosu, MS; Erin M. Collar, MPH; Amy L. Kiehl, MA; Fiona E. Harrison, PhD; Julie Bastarache, MD, PhD; Jo Ellen Wilson, MD, MPH; Matthew F. Mart, MD, MSCI; Jonathan E. Sevransky, MD, MHS; E. Wesley Ely, MD, MPH; Christopher J. Lindsell, PhD; James C. Jackson, PsyD; VICTAS Investigators; Katherine Nugent; Christine Spainhour; Carmen Polito; Brooks Moore; Lovie Negrin; Akram Khan; Bory Kea; Olivia Krol; Ebaad Haq; Vincent Pinkert; Kelly Nguyen; Samuel M Brown; Joseph Bledsoe; Ithan Peltan; Darrin Applegate; Brent Armbuster; Quinn Montgomery; Katie Brown; Austin Daw; Michelle Gong; Michael Aboodi; Jen-Ting (Tina) Chen; Aluko Hope; Swarna Gummadi; Brenda Lopez; Jeremiah Hinson; David Hager; Erin Ricketts; Johnathan Clare; Breana McBryde; Casey M. Clements; Ognjen Gajic; Rahul Kashyap; Derek Vanmeter; Laurence Busse; Mary McBride; Adit Ginde; Marc Moss; Lani Finck; Michelle Howell; Jeffrey McKeehan; Carrie Higgins; Aaron Barksdale; Dan Kalin; Derek Kruse; Katlyn Hilz; Nida Qadir; Steven Y. Chang; Rebecca Beutler; Andrea Tam; Estelle S. Harris; Scott T. Youngquist; Elizabeth A. Middleton; Ervin Davidov; Amber Plante; Justin Belsky; Jonathan Siner; Charles Wira; Carolyn Brokowski; Jay Steingrub; Howard Smithline; Sherell Thorton-Thompson; Alpha Fowler; Stephen Miller; Kyle Narron; Michael A. Pusckarich; Matthew E. Prekker; Audrey Hendrickson; James Quinn; Jennifer Wilson; Joseph Levitt; Rosen Mann; Anita Visweswaran; Nina Gentile; Nathaniel Marchetti; Hannah Reimer; Faheem Guirgis; Lisa Jones; Lauren Black; Morgan Henson; Nuala J. Meyer; John C. Greenwood; Caroline Ittner; Emanuel Rivers; Namita Jayaprakash; Jayna Gardner-Gray; Gina Hurst; Jacqueline Pflaum; Anja Kathrin Jaehne; Jasreen Gill; Aaron Cook; David R Janz; Derek Vonderhaar; Connie Romaine; R. Gentry Wilkerson; Michael T. McCurdy; Dana Beach; Kyra Lasko; Richard Gill; Katherine Price; Lisa Dickson; Abhijit Duggal; Sharon E. Mace; R. Duncan Hite; Andrei Hastings; Jason Haukoos; Ivor Dougla; Stacy Trent; Carolynn Lyle; Alicia Cupelo; Stephanie Gravitz; Terra Hiller; Judy Oakes; Frank LoVecchio; Pedro Quiroga; Shiloh Danley; Mary Mulrow; Amanda Encinas; Andrew Goodwin; Gregory Hall; Abigail Grady; Matthew Exline; Thomas Terndrup; Sonal Pannu; Emily Robart; Sarah Karow; D. Clark Files; Lane Smith; Kevin Gibbs; Lori Flores; Stephen M. Pastores; David J. Shaz; Natalie Kostelecky; Chad Chase; Elizabeth (Liz) Wilkins; David Gaieski; Michael Baram; Daniel Schwegler; Nicole Renzi; Jarrod M. Mosier; Cameron Hypes; Elizabeth Salvagio Campbell; Michael Hooper; Joshua Sill; Kate Mitchell; Kristin Hudock; Michael Lyons; Kari Gordner; Yousef Ahmad; Autumn Studer; Jacqueline Davis; Matthew Barrett; Jason Nomura; Jennifer Knox; Pauline Park; Ivan Co ; Jakob McSparron; Robert Hyzy; Kelli McDonough; Sinan Hanna; Wesley H. Self; Matthew W. Semler; Margaret Hays; Racquel Bartz; Alexander Limkakeng; Katherine Sweeney; Rachael Woodburn; Munish Goyal; Akram Zaaqoq; Theresa Moriarty; John Oropello; Ziya Zhang
Updated Conflict of Interest Disclosures
Authors: Ralph Snyderman
Journal: JAMA (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Hydroxychloroquine Dose and Risk of Systemic Lupus Erythematosus Flares—Reply
Authors: April M. Jorge, Yuqing Zhang, Hyon K. Choi
Journal: JAMA (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
The Resourceful General Practitioner of Modern Medicine
Journal: JAMA (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal